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OMB APPROVALNo. 1117-0010
TO BE FILLED IN BY SUPPLIER
Packages Shipped
Date Shipped
See Reverse of PURCHASER’S Copy for Instructions
TO: (Name of Supplier)
CITY and STATE
TO BE FILLED IN BY PURCHASER
DATESUPPLIERS DEA REGISTRATION No.
National Drug Code
STREET ADDRESS
No order form may be issued for Schedule I and II substances unless a completed application form has been received, (21 CFR 1305.04).
Name of ItemSize of Package
No. of Packages
Date Issued
LAST LINE COMPLETED (MUST BE 10 OR LESS) SIGNATURE OF PURCHASER
OR ATTORNEY OR AGENT
Name and Address of RegistrantDEA Registration No.
Schedules
Registered as a No. of this Order Form
DEA Form - 222(Date)
LINE
No.
1.
5.
2.
6.
3.
7.
4.
8.
9.
10.
U.S. OFFICIAL ORDER FORMS - SCHEDULES I & IIDRUG ENFORCEMENT ADMINISTRATION
SUPPLIER’S Copy 11XX2134710
KEEP & FILEOMB APPROVAL
No. 1117-0010
TO BE FILLED IN BY SUPPLIER
Packages Shipped
Date Shipped
See Reverse of PURCHASER’S Copy for Instructions
TO: (Name of Supplier)
CITY and STATE
TO BE FILLED IN BY PURCHASER
DATESUPPLIERS DEA REGISTRATION No.
National Drug Code
STREET ADDRESS
No order form may be issued for Schedule I and II substances unless a completed application form has been received, (21 CFR 1305.04).
Name of ItemSize of Package
No. of Packages
Date Issued
LAST LINE COMPLETED (MUST BE 10 OR LESS) SIGNATURE OF PURCHASER
OR ATTORNEY OR AGENT
Name and Address of RegistrantDEA Registration No.
Schedules
Registered as a No. of this Order Form
DEA Form - 222(Date)
LINE
No.
1.
5.
2.
6.
3.
7.
4.
8.
9.
10.
U.S. OFFICIAL ORDER FORMS - SCHEDULES I & IIDRUG ENFORCEMENT ADMINISTRATION
DEA Copy 21XX2134710
SEND TO DEAOMB APPROVAL
No. 1117-0010
TO BE FILLED IN BY SUPPLIER
Packages Shipped
Date Shipped
See Reverse of PURCHASER’S Copy for Instructions
TO: (Name of Supplier)
CITY and STATE
TO BE FILLED IN BY PURCHASER
DATESUPPLIERS DEA REGISTRATION No.
National Drug Code
STREET ADDRESS
No order form may be issued for Schedule I and II substances unless a completed application form has been received, (21 CFR 1305.04).
Name of ItemSize of Package
No. of Packages
Date Issued
LAST LINE COMPLETED (MUST BE 10 OR LESS) SIGNATURE OF PURCHASER
OR ATTORNEY OR AGENT
Name and Address of RegistrantDEA Registration No.
Schedules
Registered as a No. of this Order Form
DEA Form - 222(Date)
LINE
No.
1.
5.
2.
6.
3.
7.
4.
8.
9.
10.
U.S. OFFICIAL ORDER FORMS - SCHEDULES I & IIDRUG ENFORCEMENT ADMINISTRATION
DEA Copy 21XX2134710
2/10/2017 MedFlats | Inventory History Report
http://www.medflats.com/Print/PrintInventory.aspx 1/1
Address: 8285 Bryan Dairy Road, #160Largo, FL 33777
DEA Reg#: RP0260581State Lic.#: 062607 552 044P
Customer Return InventoryCustomer Information Wholesaler Information
Company: Largo Surgery Center Wholesaler: McKesson Address: 11211 69th St. N Address: Tester Drive Largo, FL 33773 Largo, FL 33773 Phone: (800)3573527 Account#: 123456 Fax: (727)6698327 DEA#: RP0260581 State Lic.#: 524
MedFlat ID: 1012345677 Return Date: 11/17/2014
Sample NDC Code Partial Qty Full Qty Manufacturer Description Strength Dosage ControlNo 10544059120 5 Blenheim OXYCONTIN 10 MG TER 2
SEND A COPY OF THE DEA FORM - 222 & THE
CUSTOMER RETURN INVENTORY WITH YOUR ITEMS
(2)
(1)
OMB APPROVALNo. 1117-0010
TO BE FILLED IN BY SUPPLIER
Packages Shipped Date Shipped
See Reverse of PURCHASER’S
Copy for Instructions
TO: (Name of Supplier)CITY and STATE
TO BE FILLED IN BY PURCHASER
DATE
SUPPLIERS DEA REGISTRATION No.National Drug Code
STREET ADDRESS
No order form may be issued for Schedule I and II substances unless a
completed application form has been received, (21 CFR 1305.04).
Name of Item
Size of Package
No. of Packages
Date Issued
LAST LINE COMPLETED (MUST BE 10 OR LESS) SIGNATURE OF PURCHASER
OR ATTORNEY OR AGENT
Name and Address of Registrant
DEA Registration No.
Schedules
Registered as a
No. of this Order Form
DEA Form - 222(Date)
LI
NE
No.
1.
5.
2.
6.
3.
7.
4.
8.9.
10.
U.S. OFFICIAL ORDER FORMS - SCHEDULES I & II
DRUG ENFORCEMENT ADMINISTRATION
SUPPLIER’S Copy 1
1XX2134710
AA 1234567
1
3 01/31/1701/31/17
Enter how many packages will be shipped for the corresponding product(s). *Please notify our Compliance Department if the quantities change.
Enter the date you will ship your C2 return.
1 OMB APPROVALNo. 1117-0010
TO BE FILLED IN BY SUPPLIER
Packages Shipped Date Shipped
See Reverse of PURCHASER’S
Copy for Instructions
TO: (Name of Supplier)CITY and STATE
TO BE FILLED IN BY PURCHASER
DATE
SUPPLIERS DEA REGISTRATION No.National Drug Code
STREET ADDRESS
No order form may be issued for Schedule I and II substances unless a
completed application form has been received, (21 CFR 1305.04).
Name of Item
Size of Package
No. of Packages
Date Issued
LAST LINE COMPLETED (MUST BE 10 OR LESS) SIGNATURE OF PURCHASER
OR ATTORNEY OR AGENT
Name and Address of Registrant
DEA Registration No.
Schedules
Registered as a
No. of this Order Form
DEA Form - 222(Date)
LI
NE
No.
1.
5.
2.
6.
3.
7.
4.
8.9.
10.
U.S. OFFICIAL ORDER FORMS - SCHEDULES I & II
DRUG ENFORCEMENT ADMINISTRATION
SUPPLIER’S Copy 1
1XX2134710
12341234
No. of this Order Form. Enter this number on the MedFlats® customer portal.
2
7 8
64 5
31 2
MedFlats.com
MedFlats.com/CreateAccount
LOCATE & LOG YOUR MEDFLAT ID ONLINE.
CREATE AN INVENTORY BY ENTERING THE NDC CODES.
ASSEMBLE YOUR MEDFLAT BOX TO BEGIN FILLING.
FILL BOX WITH APPROVED ITEMS.
REVIEW & FILL OUT THE FINAL PANEL.SECURE ALL TOP THREE SIDE PANELS.
FOLLOW UP ON OUR SITE TO SEE THE PROGRESS OF YOUR RETURN.
PRINT YOUR SHIPPING LABEL & PROVIDE TO THE INDICATED CARRIER.
CREATE AN ACCOUNT OR LOGINTO YOUR EXISTING ACCOUNT.
1040008073
Your MedFlat ID is located here.
SADFJSL KD FJSLFDJSL DFSADFJ SLKDFJ SLFDJSLKAJ
FLKSJDF SADFJSLKDFJSLFDJ SLKAJFL KSJDFSADFJSL
FDJSLDFJSLFDJSLDFJSL KDFJ S LFDJ SLKAJ FL
KSJDFSADFJ SLKDFJSLFD JSL KAJF LK JDFSAD FJSLKD FJ
SLFDJSLKA JFLKSJDFSADFJSL KD FJSLFDJSL KAJFLKSJ
DFSADFJ SLKDFJ S LFDJSLKAJ FLKSJDFSADFJSL
KDFJSLFDJSLKAJFL KSJDFS ADFJSL FDJSLDF
JSLFDJSLDFJSL KDF J SLFDJ SLKAJFL KSJDFSADFJ
SLKDFJSLFD JSL KAJFL K JDFSAD SADFJSL KD FJSLFDJSL
DFSADFJ SLKDFJ SLFDJSLKAJ FLKSJDF
SADFJSLKDFJSLFDJ SLKAJFL KSJDFSADFJSL
FDJSLDFJSLFDJSLDFJSL KDFJ S LFDJ SLKAJ FL
KSJDFSADFJ SLKDFJSLFD JSL KAJFLK JDFSAD FJSLKDFJ
NDC 0000 1234 56
© 201 7 PharmaLink, Inc. All Rights Reserved. Patent Pendi ng.
800.257.3527 MedFlats.com
medical re turn + d isposal sy stem
Log-on to our website for video tutorials & additional support at MedFlats.com
800.257.3527 © 2017 PharmaLink, Inc.All Rights Reserved. Patent Pendin g.
1040008073
PLEASE REGISTER THIS MEDFLAT & INVENTORY THE CONTENTS ONLINE BEFORE CONTINUING.
DO
DON’T
Attention
Provide the following information before sealing.
Contact Person__________________________________
Phone____________________________ext._________The phone number & extension of the contact person listed above.
E-Mail________________________________________
Address_______________________________________The location where this MedFlat has been prepared.
DO visit MedFlats.com for detailed instructions on generating an inventory for shipment. DO follow applicable state laws and federal regulations regarding the return and/or disposal of pharmaceuticals.
DON’T deposit used sharps or medical waste into this box.DON’T
For more help with using MedFlats® visit MedFlats.com
BOTTOM
How to use MedFlats®
MedFlat ID
Shipping Pouch
Follow the instructions printed on the outer sleeve.
Create an inventory by entering the NDC of
and seal it.
Print your shipping label and provide to the indicated carrier.
© 2017 PharmaLink, Inc. All Rights Reserved. Patent Pending.
800.257.3527 MedFlats.com
© 2017 PharmaLink, Inc. All Rights Reserved. Patent Pending.
© 2017 PharmaLink, Inc. All Rights Reserved. Patent Pending.
PLEASE REGISTER THIS MEDFLAT & INVENTORY THE CONTENTS ONLINE BEFORE CONTINUING.
DO
DON’T
Attention
Provide the following information before sealing.
Contact Person__________________________________
Phone____________________________ext._________The phone number & extension of the contact person listed above.
E-Mail________________________________________
Address_______________________________________The location where this MedFlat has been prepared.
DO visit MedFlats.com for detailed instructions on generating an inventory for shipment. DO follow applicable state laws and federal regulations regarding the return and/or disposal of pharmaceuticals.
DON’T deposit used sharps or medical waste into this box.DON’T
For more help with using MedFlats® visit MedFlats.com
© 2017 PharmaLink, Inc. All Rights Reserved. Patent Pending.
800.257.3527 MedFlats.com
6
7
54
3
COMPLETE CONTACT INFORMATION & SEAL YOUR MEDFLAT.
GO ONLINE TO SEE THE PROGRESS OF YOUR RETURN.
MedFlats.com
PRINT YOUR SHIPPING LABEL & PROVIDE TO THE INDICATED CARRIER.
MedFlats.com/CreateAccount
LOCATE & LOG YOUR MEDFLAT ID ONLINE.
CREATE AN INVENTORY BY ENTERING THE NDC CODES.
SADFJSL KD FJSLFDJSL DFSADFJ SLKDFJ SLFDJSLKAJ
FLKSJDF SADFJSLKDFJSLFDJ SLKAJFL KSJDFSADFJSL
FDJSLDFJSLFDJSLDFJSL KDFJ S LFDJ SLKAJ FL
KSJDFSADFJ SLKDFJSLFD JSL KAJF LK JDFSAD FJSLKD FJ
SLFDJSLKA JFLKSJDFSADFJSL KD FJSLFDJSL KAJFLKSJ
DFSADFJ SLKDFJ S LFDJSLKAJ FLKSJDFSADFJSL
KDFJSLFDJSLKAJFL KSJDFS ADFJSL FDJSLDF
JSLFDJSLDFJSL KDF J SLFDJ SLKAJFL KSJDFSADFJ
SLKDFJSLFD JSL KAJFL K JDFSAD SADFJSL KD FJSLFDJSL
DFSADFJ SLKDFJ SLFDJSLKAJ FLKSJDF
SADFJSLKDFJSLFDJ SLKAJFL KSJDFSADFJSL
FDJSLDFJSLFDJSLDFJSL KDFJ S LFDJ SLKAJ FL
KSJDFSADFJ SLKDFJSLFD JSL KAJFLK JDFSAD FJSLKDFJ
NDC 0000 1234 56Your MedFlat ID is located here.
CREATE AN ACCOUNT OR LOGINTO YOUR EXISTING ACCOUNT. 1 2
PLEASE VERIFY THAT YOU HAVE COMPLETED THE LIST BELOW BEFORE SUBMITTING YOUR INVENTORY.
Register this �at at MedFlats.com.
Inventory the contents online.
Fill out the information on the opposite side of this postcard.
Attention YOU MUST REGISTER THIS MEDFLAT & INVENTORY
THE CONTENTS ONLINE BEFORE CONTINUING.
Please provide the following information before sealing.
Contact Person
The person who has prepared this speci�c MedFlat.
Phone
ext.
The phone number & extension of the contact person listed above.
The o�ce e-mail of the contact person listed above.
Address
The location where this MedFlat has been prepared.
DO login or create an account at MedFlats.com to access
detailed instructions on generating an inventory and to
print a carrier label for shipment.
DO follow applicable state laws and federal regulations
regarding the return and/or disposal of pharmaceuticals.
DON’T deposit used sharps or medical waste into
this package.
DON’T over�ll. Maximum return weight for this
MedFlat is 13 oz.
For more help with using MedFlats® visit MedFlats.com
DO
DON’T
P 800.257.3527 F 727.669.8327
FILL WITH APPROVED ITEMS.
1040008073
1040
0080
73
SEN
DIN
VEN
TORY
FILL
& S
EAL
SEN
DIN
VEN
TORY
FILL
& S
EAL
SEN
DIN
VEN
TORY
FILL
& S
EAL
SEN
DIN
VEN
TORY
FILL
& S
EAL
SENDINVENTORY FILL & SEAL
medical return + disposal system
Log-on to our website for additional support at MedFlats.com
SEND
INV
ENTO
RYFILL &
SEAL
SEND
INV
ENTO
RYFILL &
SEAL
SEND
INV
ENTO
RYFILL &
SEAL
SEND
INV
ENTO
RYFILL &
SEAL
Log-on to our website for additional support at
.COM
800.257.3527 © 2017 PharmaLink, Inc. All Rights Reserved. 800.257.3527 © 2017 PharmaLink, Inc. All Rights Reserved.
6
7
54
3
COMPLETE CONTACT INFORMATION & SEAL YOUR MEDFLAT.
GO ONLINE TO SEE THE PROGRESS OF YOUR RETURN.
MedFlats.com
PRINT YOUR SHIPPING LABEL & PROVIDE TO THE INDICATED CARRIER.
MedFlats.com/CreateAccount
LOCATE & LOG YOUR MEDFLAT ID ONLINE.
CREATE AN INVENTORY BY ENTERING THE NDC CODES.
SADFJSL KD FJSLFDJSL DFSADFJ SLKDFJ SLFDJSLKAJ
FLKSJDF SADFJSLKDFJSLFDJ SLKAJFL KSJDFSADFJSL
FDJSLDFJSLFDJSLDFJSL KDFJ S LFDJ SLKAJ FL
KSJDFSADFJ SLKDFJSLFD JSL KAJF LK JDFSAD FJSLKD FJ
SLFDJSLKA JFLKSJDFSADFJSL KD FJSLFDJSL KAJFLKSJ
DFSADFJ SLKDFJ S LFDJSLKAJ FLKSJDFSADFJSL
KDFJSLFDJSLKAJFL KSJDFS ADFJSL FDJSLDF
JSLFDJSLDFJSL KDF J SLFDJ SLKAJFL KSJDFSADFJ
SLKDFJSLFD JSL KAJFL K JDFSAD SADFJSL KD FJSLFDJSL
DFSADFJ SLKDFJ SLFDJSLKAJ FLKSJDF
SADFJSLKDFJSLFDJ SLKAJFL KSJDFSADFJSL
FDJSLDFJSLFDJSLDFJSL KDFJ S LFDJ SLKAJ FL
KSJDFSADFJ SLKDFJSLFD JSL KAJFLK JDFSAD FJSLKDFJ
NDC 0000 1234 56Your MedFlat ID is located here.
CREATE AN ACCOUNT OR LOGINTO YOUR EXISTING ACCOUNT. 1 2
PLEASE VERIFY THAT YOU HAVE COMPLETED THE LIST BELOW BEFORE SUBMITTING YOUR INVENTORY.
Register this �at at MedFlats.com.
Inventory the contents online.
Fill out the information on the opposite side of this postcard.
Attention YOU MUST REGISTER THIS MEDFLAT & INVENTORY
THE CONTENTS ONLINE BEFORE CONTINUING.
Please provide the following information before sealing.
Contact Person
The person who has prepared this speci�c MedFlat.
Phone ext.
The phone number & extension of the contact person listed above.
The o�ce e-mail of the contact person listed above.
Address
The location where this MedFlat has been prepared.
DO login or create an account at MedFlats.com to access
detailed instructions on generating an inventory and to
print a carrier label for shipment.
DO follow applicable state laws and federal regulations
regarding the return and/or disposal of pharmaceuticals.
DON’T deposit used sharps or medical waste into
this package.
DON’T over�ll. Maximum return weight for this
MedFlat is 13 oz.
For more help with using MedFlats® visit MedFlats.com
DO
DON’T
P 800.257.3527 F 727.669.8327
FILL WITH APPROVED ITEMS.
1040008073
1040008073
SENDINVENTORY
FILL & SEALSEND
INVENTORYFILL & SEAL
SENDINVENTORY
FILL & SEALSEND
INVENTORYFILL & SEAL
SENDINVENTORY FILL & SEAL
medical return + disposal system
Log-on to our website for video tutorials & additional support at MedFlats.com
SENDINVENTORYFILL & SEAL
SENDINVENTORY FILL & SEAL
SENDINVENTORY FILL & SEAL
SENDINVENTORY FILL & SEAL
Log-on to our website for video tutorials & additional support at .COM
800.257.3527 © 2017 PharmaLink, Inc.All Rights Reserved. Patent Pending. 800.257.3527 © 2017 PharmaLink, Inc.All Rights Reserved. Patent Pending.
6
7
54
3
COMPLETE CONTACT INFORMATION & SEAL YOUR MEDFLAT.
GO ONLINE TO SEE THE PROGRESS OF YOUR RETURN.
MedFlats.com
PRINT YOUR SHIPPING LABEL & PROVIDE TO THE INDICATED CARRIER.
MedFlats.com/CreateAccount
LOCATE & LOG YOUR MEDFLAT ID ONLINE. CREATE AN INVENTORY BY ENTERING THE NDC CODES.
NDC 0000 1234 56Your MedFlat ID is located here.
CREATE AN ACCOUNT OR LOGINTO YOUR EXISTING ACCOUNT. 1 2
Attention
FILL WITH APPROVED ITEMS.
1040008073
SENDINVENTORY
FILL & SEALSEND
INVENTORYFILL & SEAL
SENDINVENTORY
FILL & SEALSEND
INVENTORYFILL & SEAL
SENDINVENTORY FILL & SEAL
medical return + disposal system
Log-on to our website for video tutorials & additional support at MedFlats.com
SENDINVENTORYFILL & SEAL
SENDINVENTORY FILL & SEAL
SENDINVENTORY FILL & SEAL
SENDINVENTORY FILL & SEAL
Log-on to our website for video tutorials & additional support at .COM
800.257.3527 © 2017 PharmaLink, Inc.All Rights Reserved. Patent Pending. 800.257.3527 © 2017 PharmaLink, Inc.All Rights Reserved. Patent Pending.
6
7
54
3
COMPLETE CONTACT INFORMATION & SEAL YOUR MEDFLAT.
GO ONLINE TO SEE THE PROGRESS OF YOUR RETURN.
MedFlats.com
PRINT YOUR SHIPPING LABEL & PROVIDE TO THE INDICATED CARRIER.
MedFlats.com/CreateAccount
LOCATE & LOG YOUR MEDFLAT ID ONLINE. CREATE AN INVENTORY BY ENTERING THE NDC CODES.
NDC 0000 1234 56Your MedFlat ID is located here.
CREATE AN ACCOUNT OR LOGINTO YOUR EXISTING ACCOUNT. 1 2
Attention
FILL WITH APPROVED ITEMS.
1040
0080
73
SEN
DIN
VEN
TORY
FILL
& S
EAL
SEN
DIN
VEN
TORY
FILL
& S
EAL
SEN
DIN
VEN
TORY
FILL
& S
EAL
SEN
DIN
VEN
TORY
FILL
& S
EAL
SENDINVENTORY FILL & SEAL
medical return + disposal system
Log-on to our website for additional support at MedFlats.com
SEND
INV
ENTO
RYFILL &
SEAL
SEND
INV
ENTO
RYFILL &
SEAL
SEND
INV
ENTO
RYFILL &
SEAL
SEND
INV
ENTO
RYFILL &
SEAL
Log-on to our website for additional support at
.COM
800.257.3527 © 2017 PharmaLink, Inc. All Rights Reserved. 800.257.3527 © 2017 PharmaLink, Inc. All Rights Reserved.
6
7
54
3
COMPLETE CONTACT INFORMATION & SEAL YOUR MEDFLAT.
GO ONLINE TO SEE THE PROGRESS OF YOUR RETURN.
MedFlats.com
PRINT YOUR SHIPPING LABEL & PROVIDE TO THE INDICATED CARRIER.
MedFlats.com/CreateAccount
LOCATE & LOG YOUR MEDFLAT ID ONLINE.
CREATE AN INVENTORY BY ENTERING THE NDC CODES.
SADFJSL KD FJSLFDJSL DFSADFJ SLKDFJ SLFDJSLKAJ
FLKSJDF SADFJSLKDFJSLFDJ SLKAJFL KSJDFSADFJSL
FDJSLDFJSLFDJSLDFJSL KDFJ S LFDJ SLKAJ FL
KSJDFSADFJ SLKDFJSLFD JSL KAJF LK JDFSAD FJSLKD FJ
SLFDJSLKA JFLKSJDFSADFJSL KD FJSLFDJSL KAJFLKSJ
DFSADFJ SLKDFJ S LFDJSLKAJ FLKSJDFSADFJSL
KDFJSLFDJSLKAJFL KSJDFS ADFJSL FDJSLDF
JSLFDJSLDFJSL KDF J SLFDJ SLKAJFL KSJDFSADFJ
SLKDFJSLFD JSL KAJFL K JDFSAD SADFJSL KD FJSLFDJSL
DFSADFJ SLKDFJ SLFDJSLKAJ FLKSJDF
SADFJSLKDFJSLFDJ SLKAJFL KSJDFSADFJSL
FDJSLDFJSLFDJSLDFJSL KDFJ S LFDJ SLKAJ FL
KSJDFSADFJ SLKDFJSLFD JSL KAJFLK JDFSAD FJSLKDFJ
NDC 0000 1234 56Your MedFlat ID is located here.
CREATE AN ACCOUNT OR LOGINTO YOUR EXISTING ACCOUNT. 1 2
PLEASE VERIFY THAT YOU HAVE COMPLETED THE LIST BELOW BEFORE SUBMITTING YOUR INVENTORY.
Register this �at at MedFlats.com.
Inventory the contents online.
Fill out the information on the opposite side of this postcard.
Attention YOU MUST REGISTER THIS MEDFLAT & INVENTORY
THE CONTENTS ONLINE BEFORE CONTINUING.
Please provide the following information before sealing.
Contact Person
The person who has prepared this speci�c MedFlat.
Phone ext.
The phone number & extension of the contact person listed above.
The o�ce e-mail of the contact person listed above.
Address
The location where this MedFlat has been prepared.
DO login or create an account at MedFlats.com to access
detailed instructions on generating an inventory and to
print a carrier label for shipment.
DO follow applicable state laws and federal regulations
regarding the return and/or disposal of pharmaceuticals.
DON’T deposit used sharps or medical waste into
this package.
DON’T over�ll. Maximum return weight for this
MedFlat is 13 oz.
For more help with using MedFlats® visit MedFlats.com
DO
DON’T
P 800.257.3527 F 727.669.8327
FILL WITH APPROVED ITEMS.
1040008073
1040008073
SENDINVENTORY
FILL & SEALSEND
INVENTORYFILL & SEAL
SENDINVENTORY
FILL & SEALSEND
INVENTORYFILL & SEAL
SENDINVENTORY FILL & SEAL
medical return + disposal system
Log-on to our website for video tutorials & additional support at MedFlats.com
SENDINVENTORYFILL & SEAL
SENDINVENTORY FILL & SEAL
SENDINVENTORY FILL & SEAL
SENDINVENTORY FILL & SEAL
Log-on to our website for video tutorials & additional support at .COM
800.257.3527 © 2017 PharmaLink, Inc.All Rights Reserved. Patent Pending. 800.257.3527 © 2017 PharmaLink, Inc.All Rights Reserved. Patent Pending.
6
7
54
3
COMPLETE CONTACT INFORMATION & SEAL YOUR MEDFLAT.
GO ONLINE TO SEE THE PROGRESS OF YOUR RETURN.
MedFlats.com
PRINT YOUR SHIPPING LABEL & PROVIDE TO THE INDICATED CARRIER.
MedFlats.com/CreateAccount
LOCATE & LOG YOUR MEDFLAT ID ONLINE. CREATE AN INVENTORY BY ENTERING THE NDC CODES.
NDC 0000 1234 56Your MedFlat ID is located here.
CREATE AN ACCOUNT OR LOGINTO YOUR EXISTING ACCOUNT. 1 2
Attention
FILL WITH APPROVED ITEMS.
1040008073
SENDINVENTORY
FILL & SEALSEND
INVENTORYFILL & SEAL
SENDINVENTORY
FILL & SEALSEND
INVENTORYFILL & SEAL
SENDINVENTORY FILL & SEAL
medical return + disposal system
Log-on to our website for video tutorials & additional support at MedFlats.com
SENDINVENTORYFILL & SEAL
SENDINVENTORY FILL & SEAL
SENDINVENTORY FILL & SEAL
SENDINVENTORY FILL & SEAL
Log-on to our website for video tutorials & additional support at .COM
800.257.3527 © 2017 PharmaLink, Inc.All Rights Reserved. Patent Pending. 800.257.3527 © 2017 PharmaLink, Inc.All Rights Reserved. Patent Pending.
6
7
54
3
COMPLETE CONTACT INFORMATION & SEAL YOUR MEDFLAT.
GO ONLINE TO SEE THE PROGRESS OF YOUR RETURN.
MedFlats.com
PRINT YOUR SHIPPING LABEL & PROVIDE TO THE INDICATED CARRIER.
MedFlats.com/CreateAccount
LOCATE & LOG YOUR MEDFLAT ID ONLINE. CREATE AN INVENTORY BY ENTERING THE NDC CODES.
NDC 0000 1234 56Your MedFlat ID is located here.
CREATE AN ACCOUNT OR LOGINTO YOUR EXISTING ACCOUNT. 1 2
Attention
FILL WITH APPROVED ITEMS.
1
Enter your DEA number.
COMPLETING YOUR DEA FORM 222
Keep the Brown DEA Form - 222 copy along with your return paperwork for your future records.
Please send your Green DEA Form - 222 copy to your local DEA Field office.
Include a copy of your DEA Form - 222 &the MedFlat Customer Return Inventory.
3
To find your local DEA office, visithttp://www.deadiversion.usdoj.gov/
& click on the “Find your local DEA office” link.
IMPORTANT: This form is TIME SENSITIVE and WILL EXPIRE 60 DAYS from the date issued. If more than 10 NDC’s have been submitted, multiple forms will be required to complete your C2 return.
1. COMPLETING THE DEA FORM - 222INDICATE the total number of packages to be shipped and the DATE YOU INTEND TO SHIP your
C2 inventory.
2. ENTERING ORDER FORM NO. & PRINTING A CARRIER LABELLogin to the Customer Portal and EDIT the open inventory with the status indicating “Awaiting
Form - 222”. Enter your DEA Form - 222 No., found in the bottom-left portion of the form under the
heading No. of this Order Form, and click SUBMIT. You will be prompt to validate your MedFlat ID
Number. A carrier label will automatically generate in a new tab.
*If your MedFlat already has a carrier label, enter your MedFlat ID and tracking number before
selecting SUBMIT.
3. DEA FORM - 222 & COPIESKeep the top copy (brown ink) along with your return paperwork for your records, forward the
middle copy (green ink) to your local DEA field office. Make a copy of the DEA Form - 222(1) and
your MedFlat Customer Return Inventory(2), then include both forms with your flat before sealing
and sending.
A D D I T I O N A L I N F O R M AT I O N R E G A R D I N G P R O P E R S H I P M E N T O F M E D F L AT S ® I S AVA I L A B L E O N L I N E
AT M E D F L AT S . CO M / S U P P O R T. A S PX O R YO U C A N CO N TAC T U S AT 800.257.3527.
Preparing your DEA Form - 222
